Treatment of Sinus Tachycardia (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Hi, welcome to this portion of our video series on electrocardiograms.

    00:05 In this one, we're going to talk about how you treat sinus tachycardia.

    00:09 Now I'm really tempted to talk very quickly because this is super fast rhythm.

    00:14 However, I'm going to slow down so you can understand what I'm saying.

    00:19 Now speaking of slowing down, when you look at normal sinus rhythm, the difference between normal sinus rhythm and sinus tachycardia is simply the rate.

    00:30 Normal sinus rhythm is 60 to 100, and then you have for sinus tachycardia greater than 100.

    00:37 So in normal sinus rhythm, you guys know that we have a normal P wave before every QRS complex, The rhythm is regular, but it can vary during respirations.

    00:48 The P wave is positive.

    00:49 That means if you look at the isoelectric line, it is above the isoelectric line and it's positive in leads I, lead II and you'll also see it be biphasic in lead V1.

    01:01 Remember the range of normal sinus rhythm is 60 to 100.

    01:06 Now, Let's speed this up, because sinus tachycardia is faster.

    01:13 The heart rate is greater than 100, the rhythm is still regular, you have a P wave before every QRS, they all look the same.

    01:20 The PR interval is normal, and the QRS is normal.

    01:25 Now let's talk about the causes of sinus tachycardia.

    01:28 I feel like we're in therapy because some of the causes of tachycardia are what we all live on.

    01:35 Caffeine.

    01:36 If you're in school for any program, you probably are drinking way too much caffeine.

    01:44 So keep that in mind.

    01:45 That is a cause of sinus tachycardia and you will feel your heart rate just Now, some people are really sensitive to caffeine, other people can kick it back without much impact, but keep in mind if you're feeling your heart rate be elevated, caffeine is likely a culprit.

    02:05 Now other things include alcohol, nicotine, stimulant drugs, like your friend cocaine and methamphetamine.

    02:12 No, I'm just kidding.

    02:13 They are not your friend, but any stimulant drug will elevate your heart rate and can put you in an increased risk for sinus tachycardia.

    02:22 Pain. That's a big one as a nurse.

    02:26 If a patient is in pain, if you notice that their heart rate is elevated, and you ask them how they're feeling, and they're like, 'I'm fine', but their heart rate is really elevated, you're gonna want to ask some more questions.

    02:38 That's also another way that we can monitor a patient who for some reason can't speak to us or isn't awake.

    02:45 If we noticed their heart rate going up, we need to follow up and see what the problem is.

    02:50 Now an underactive thyroid or hypothyroidism can cause sinus brady.

    02:56 So it makes sense that an overactive thyroid or hyperthyroidism can cause tachycardia.

    03:04 Other things include fever, anxiety, anemia, and hypovolemia.

    03:10 Okay, now, you know, I just like to give you a list.

    03:13 Let's tell you the "whys" behind these.

    03:16 Caffeine, alcohol, nicotine, we're mostly familiar with those and stimulant drugs that makes sense.

    03:22 When you hurt, you know, you don't feel calm when you feel pain.

    03:26 That should make sense why your heart rate goes up.

    03:29 Thyroid, hey, everybody wants a little bit of an overactive thyroid so we could eat what we want without any consequence, but with extra thyroid hormone in your body, it's going to stimulate everything.

    03:41 You're going to be warmer, and that heart rate is going to be faster.

    03:46 Fever, oh, that's really tough on the body.

    03:49 It is amazing what a fever can do.

    03:51 In fact, it's the body's way of you know, killing things that shouldn't be living in there.

    03:56 So sometimes fever serves a really good purpose.

    04:00 But along with that extra elevation in temperature, you'll have an elevation in heart rate.

    04:05 Anxiety, hmm, you get that feeling in your stomach and you feel really anxious, you start to breathe faster, like I don't know, right before or during a Nursing exam? That's what can cause a sinus tachycardia.

    04:18 When the anxiety is relieved, we should be able to bring that back down to more normal.

    04:23 Now anemia.

    04:24 That one is really interesting.

    04:27 So think about it.

    04:28 First of all, what is anemia? Well, it is low red blood cells.

    04:33 What do red blood cells do? Well, they're literally just sacks that carry four hemoglobins, right? Well, infants have a little more but adults have four hemoglobin carriers, right? And hemoglobin is what carries the oxygen.

    04:50 So that's all a red blood cell does.

    04:53 If I don't have enough red blood cells, uh oh, my body is not getting oxygenated.

    05:00 It's not delivering, it's not being perfused because oxygen is not being delivered to my tissues.

    05:07 So how does the body compensate? The heart beats faster, trying to help you stay on top of things and get more delivery.

    05:13 So you have fewer red blood cells, so your body amazing, just moves the fewer red blood cells you have around faster.

    05:23 That's how anemia works, will cause possible sinus tachycardia.

    05:28 So consider each one of these causes as you're thinking it through.

    05:33 Now we save the biggest one for last.

    05:36 This seems to come up on exams all the time.

    05:39 If someone is in hypovolemia, it's part of their blood, right Because we have -emia, but it says hypo- meaning low volume.

    05:50 Okay, now when I have low volume in my circulatory system, what impact will that have on my blood pressure? My blood pressure will be lower.

    06:01 My body and my brain knows, if I have too low a blood pressure, I'm not going to be able to again perfuse all my tissues.

    06:13 So if somebody is low on volume, how does the body fix it? It vasoconstricts, and it elevates the heart rate to keep you alive.

    06:24 So if you have a patient, or a test question, where the patient's vitals, have a blood pressure that drops below 100, and a heart rate that's above 100, and let's say they've recently had surgery, or they're at risk for bleeding, or being incredibly dehydrated, think about hypovolemia as the cause of the sinus tachycardia.

    06:48 Okay, now that is quite a list.

    06:51 So you know, your job is, pause the video, think about how you can group those things together so it makes sense in your mind, what the causes are of tachycardia.

    07:00 So pause it, take a minute and then come back and rejoin us.

    07:07 Okay, welcome back.

    07:08 But with this many causes, gosh, how are we going to fix all this? How do we fix sinus tachycardia? Well, the answer is, we have to resolve the underlying cause of the elevated heart rate.

    07:23 So let's go back through that list for just a second.

    07:26 So caffeine, we're going to need you to slow down on the caffeine but be very careful.

    07:32 If you've been taking significantly large amounts of caffeine, don't just stop cold turkey, you will wish you hadn't, you'll have the worst headache and even possibly go through a type of depression.

    07:45 So we wean that down.

    07:46 Alcohol, same thing wean that down.

    07:49 Nicotine, wow if you've ever smoked, you know that that's a really difficult habit to stop, especially if you're smoking or vaping, it's going to be a real challenge.

    08:00 So get some help in kicking that one.

    08:03 Cocaine and meth, we're just going to pretty much recommend here at Lecturio that you don't do those.

    08:09 But if you're on other prescribed stimulants, you also need to watch your heart rate pretty closely Pain, we're going to relieve it.

    08:16 Overactive thyroid, we're going to give you a medication that will deal with that extra thyroid.

    08:20 Fever. We're going to let you go a little bit to see if it needs to fry that bug but we're going to keep a close eye on it So it doesn't overstress your body Anxiety, we're going to treat the underlying cause of that.

    08:32 Consider medication and therapy because that is miserable for patients.

    08:37 Anemia, we got to figure out what type of anemia it is so we can fix it.

    08:42 Hypovolemia, we're going to give you some fluids and we may even need to give you some blood products.

    08:47 So sinus tachycardia treatment involves identifying what the cause is, and resolving that.

    08:56 Before you can fix the underlying cause, as a nurse, you need to be at the top of your game to identify what is the underlying cause.

    09:05 Well, how do I do that? Well, you can ask questions of the patient, process of elimination, you need to know all the things that could cause sinus tachycardia and then see if those are appropriate for your patient.

    09:18 Now in Sinus tach, the electrical impulses are conducting appropriately through the heart but are firing at an elevated rate of greater than 100 a minute.

    09:30 Thank you for watching our video today.

    About the Lecture

    The lecture Treatment of Sinus Tachycardia (Nursing) by Rhonda Lawes, PhD, RN is from the course Analysis of Abnormal ECG Strips (Nursing).

    Included Quiz Questions

    1. Caffeine
    2. Alcohol
    3. Nicotine
    4. Pain
    5. Antidepressants
    1. Hyperthyroidism
    2. Hypothyroidism
    3. Obstructive sleep apnea
    4. Coronary heart disease
    1. Elevated temperature
    2. Elevated heart rate
    3. Low red blood cells
    4. Hypovolemia
    5. High red blood cells
    1. "Limit caffeine intake."
    2. "Limit intake of alcohol."
    3. "Stop smoking."
    4. "Lessen daily exercises."
    5. "Increase caffeine intake."
    1. Occurs before each QRS
    2. Occurs after each QRS
    3. No P wave
    4. Sawtooth P wave

    Author of lecture Treatment of Sinus Tachycardia (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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